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SBI Retail health is a relatively inexpensive policy. But it has a couple of restrictions. It only offers few benefits. And if you’re looking for a policy that offers comprehensive coverage, this one might be a letdown.

What's good here?

You may pay a portion of the bill

On most occasions the insurer will pay your medical bills in full up to the sum insured — no questions asked. However, if you were forced to be treated in a hospital that’s not a part of their network, then they’ll make you co-pay 10% of the final bill.

You always have full cover irrespective of the disease

No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.

Day Care treatments covered

If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.

What's bad here?

Restrictions on the rooms you can pick and much more

Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more - Read more here

Long waiting period for pre-existing diseases

If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems only after 4 long years. It could be much shorter you know? Like 2 years perhaps!

What's okay?

Pre & Post hospitalization expenses covered up to a certain limit

No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount upto 10% of sum insured for about 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.

Some coverage if you are forced to hospitalize at home

The insurer will pay up to ₹20,000 if you are forced to hospitalize at home due to a medical condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.

Some Cover for Alternative Medicine

Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will pay up to ₹15,000 of the cover in case you’re availing these treatments.

What's lacking here?

No Restoration Benefit

Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.

Underwhelming bonus feature

Your sum insured increases by 5% each year, so long as you make no claims during this period. But before you get too ahead of yourself, do note that they’ll stop offering you the bonus when your sum insured increases by 25%. And while this is a decent deal, most insurance companies offer a much higher bonus. But hey, it's still a bonus.

No free Health Checkups unless you wait 4 years

If you’re planning on getting a full body checkup just to make sure you’re in fine working condition, the insurer will cover the cost once in 4 years. However, just so you know, most insurance policies offer free yearly health checkups.

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